發(fā)布時(shí)間：2018-09-17 15:13

【摘要】：目的:探討人工膝關(guān)節(jié)置換術(shù)中應(yīng)用高屈曲旋轉(zhuǎn)平臺(tái)假體與高性能固定平臺(tái)假體臨床療效。方法:回顧性研究分析自2014年1月至2014年12月在我科行全膝關(guān)節(jié)置換術(shù)患者83例(86膝),依據(jù)使用假體類型的不同將患者分為高屈曲旋轉(zhuǎn)平臺(tái)假體(High flexion rotating platform,RPF)組(46例,47膝)和高性能固定平臺(tái)假體(High performance fixed platform,HFB)組(37例,39膝)。采集患者基本資料,包括性別、年齡、患側(cè)、體重指數(shù)和圍手術(shù)期出血量等。所有隨訪患者依據(jù)影像學(xué)資料應(yīng)用Kellgren-Lawrence分級(jí)標(biāo)準(zhǔn)對(duì)關(guān)節(jié)炎進(jìn)行影像學(xué)分級(jí)。所有患者均由一名長(zhǎng)期從事關(guān)節(jié)置換手術(shù)的高年資醫(yī)師主刀完成,兩組患者假體及骨水泥均由美國(guó)強(qiáng)生公司Depuy提供,術(shù)后所有患者按照統(tǒng)一的康復(fù)方案行患肢功能鍛煉。所有患者均獲得隨訪,隨訪時(shí)間為2年,隨訪內(nèi)容包括:1.美國(guó)特種外科醫(yī)院膝關(guān)節(jié)評(píng)分(Hospital for special surgery knee score,HSS),參照末次隨訪評(píng)分計(jì)算優(yōu)良率(優(yōu)大于等于85分,良70~84分,中60~69分,差小于59分);2.膝關(guān)節(jié)活動(dòng)度(range of motion,ROM);3.術(shù)前、術(shù)后1周、術(shù)后6個(gè)月及術(shù)后2年隨訪時(shí)膝關(guān)節(jié)正側(cè)位片;4.是否有膝關(guān)節(jié)置換術(shù)后并發(fā)癥發(fā)生。通過HSS評(píng)分評(píng)估患者膝關(guān)節(jié)疼痛程度及功能情況,通過影像學(xué)資料了解假體位置情況、是否有假體松動(dòng)、假體下沉、骨溶解等。結(jié)果:所有患者均獲得隨訪。其中RPF組患者46例(47膝),男6例,女40例;年齡47~82(64.2±8.6)歲;右膝28例,左膝19例;體重指數(shù)25.8±3.5kg/m~2;骨關(guān)節(jié)炎影像學(xué)分級(jí)Ⅲ級(jí)31例,Ⅳ級(jí)16例;圍手術(shù)期出血量1016.7±240.1ml。HFB組患者37例(39膝),男11例,女26例;年齡52~81(64.9±8.1)歲;右膝19例,左膝20例;體重指數(shù)26.1±3.9kg/m~2;骨關(guān)節(jié)炎影像學(xué)分級(jí)Ⅲ級(jí)26例,Ⅳ級(jí)13例;圍手術(shù)期出血量1012.3±297.9ml。分別將RPF組和HFB組患者年齡、患側(cè)、性別比、體重指數(shù)、骨關(guān)節(jié)炎影像學(xué)分級(jí)、圍手術(shù)期出血量進(jìn)行統(tǒng)計(jì)學(xué)分析,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),兩組資料具有可比性。所有患者術(shù)后切口均為一期愈合,無(wú)皮膚壞死、切口感染發(fā)生。至末次隨訪,所有患者無(wú)假體松動(dòng)、假體下沉、下肢深靜脈血栓形成等。所有患者無(wú)髕骨骨折、髕骨脫位及髕韌帶損傷等并發(fā)癥發(fā)生,但RPF組中有6例患者、HFB組中有4例患者出現(xiàn)關(guān)節(jié)摩擦音或關(guān)節(jié)彈響的問題,經(jīng)比較兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。HSS評(píng)分術(shù)前RPF組為33.8±4.1分、HFB組為34.2±3.7分;末次隨訪RPF組為90.3±3.5分、HFB組為89.4±4.4分。兩組末次隨訪與術(shù)前HSS評(píng)分比較差異有統(tǒng)計(jì)學(xué)意義(P0.001);兩組末次隨訪HSS評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。末次隨訪RPF組HSS評(píng)分優(yōu)39例,良5例,中3例,差0例,優(yōu)良率為93.6%;HFB組HSS評(píng)分優(yōu)32例,良5例,中2例,差0例,優(yōu)良率為94.8%,兩組優(yōu)良率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。膝關(guān)節(jié)活動(dòng)度術(shù)前RPF組為86.0±9.4°、HFB組為84.4±9.3°;末次隨訪RPF組為123.8±18.4°、HFB組為110.8±9.6°。兩組膝關(guān)節(jié)活動(dòng)度末次隨訪與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義(P0.001);末次隨訪膝關(guān)節(jié)活動(dòng)度兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.001)。結(jié)論:1.RPF假體與HFB假體在臨床療效上相類似,患者滿意度均較高,但RPF假體可獲得較高的關(guān)節(jié)活動(dòng)度,更加適用于對(duì)膝關(guān)節(jié)活動(dòng)度要求較高的患者。2.RPF假體襯墊旋轉(zhuǎn)作用可提供患者較佳的膝關(guān)節(jié)調(diào)節(jié)能力,上下樓梯等動(dòng)作效果更佳。3.因本研究為2年的中期隨訪,隨訪時(shí)間相對(duì)較短,且樣本數(shù)量少,其遠(yuǎn)期臨床療效需進(jìn)一步觀察。
[Abstract]:Objective: To evaluate the clinical efficacy of high flexion rotary platform prosthesis and high performance fixed platform prosthesis in total knee arthroplasty (TKA).Methods: A retrospective study was conducted in 83 patients (86 knees) who underwent total knee arthroplasty from January 2014 to December 2014. High flexion rotating platform (RPF) group (46 cases, 47 knees) and high performance fixed platform (HFB) group (37 cases, 39 knees). Basic data of patients, including sex, age, affected side, body mass index and perioperative bleeding volume, were collected. All patients were followed up according to imaging data using Kellgren-Lawrence classification. All patients were performed with a senior surgeon's knife. Prostheses and bone cement were provided by Depuy, a Johnson & Johnson Company in the United States. All patients performed functional exercises according to a unified rehabilitation program. All patients were followed up for a period of time. For 2 years, follow-up included: 1. Hospital for Special Surgery knee score (HSS), according to the final follow-up score, the excellent and good rate was calculated (excellent or equal to 85 points, good 70-84 points, middle 60-69 points, difference less than 59 points); 2. range of motion (ROM); 3. Posterior and lateral radiographs of knee joint were taken at 2-year follow-up.4.Whether complications occurred after knee replacement.The degree of pain and function of knee joint were evaluated by HSS score. (47 knees), male 6, female 40; age 47-82 (64.2 (+ 8.6) years old; right 28, left 19; body mass index 25.8 (+ 3.5 kg / M ~ 2); osteoarthritis imaging grade III 31 cases, grade IV 16 cases; perioperative blood loss 1016.7 (+ 240.1 ml). HFB group 37 cases (39 knees), male 11 cases, female 26 cases; age 52-81 (64.9 (+ 8.1) years old; right 19 cases, left 20 cases; body mass index 26.9 (+ 8.9). There were 26 cases of osteoarthritis grade III and 13 cases of osteoarthritis grade IV. The perioperative bleeding volume was 1012.3 (+ 297.9 ml). Age, sex ratio, body mass index, osteoarthritis imaging grade and perioperative bleeding volume of RPF group and HFB group were statistically analyzed. There was no significant difference between the two groups (P 0.05). At the last follow-up, no prosthesis loosening, prosthesis subsidence, deep venous thrombosis of the lower extremity, etc. No patellar fracture, patellar dislocation, patellar ligament injury and other complications occurred in all patients, but there were 6 cases in RPF group and 4 cases in HFB group. There was no significant difference between the two groups (P 0.05). HSS score was 33.8 (+ 4.1) in RPF group and 34.2 (+ 3.7) in HFB group before operation, 90.3 (+ 3.5) in RPF group and 89.4 (+ 4.4) in HFB group at the last follow-up. There was no significant difference in HSS score between the two groups (P 0.05). At the last follow-up, there were 39 excellent, 5 good, 3 middle and 0 poor HSS scores in RPF group, and the excellent and good rate was 93.6%. In HFB group, there were 32 excellent, 5 good, 2 poor, and 0 poor HSS scores, the excellent and good rate was 94.8%. There was no significant difference in the excellent and good rate between the two groups (P 0.05). There was a significant difference between the two groups in the final follow-up (P 0.001) and the preoperative (P 0.001). Conclusion: 1. RPF prosthesis and HFB prosthesis were similar in clinical efficacy and patient satisfaction. RPF prosthesis can obtain higher joint mobility, which is more suitable for patients with higher knee mobility requirements. 2. RPF prosthesis pad rotation can provide better knee adjustment ability, better up and down stairs movement effect. 3. Because this study is a two-year mid-term follow-up, follow-up time is relatively short, and sample size. The short term clinical efficacy should be further observed.
【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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